January 1, 2005

ARTICLES: After the trauma - Children involved in the disaster need special help

AFTER THE TRAUMA - Children involved in the disaster need special help


The lovely blonde-haired boy seemed to be around three years old _ old enough to talk. But he did not utter a word to anyone. A nurse and then translator asked him his name, his parents, his country, if he wanted anything.

But the young survivor of the weekend tragedy just sat still and silent, only his eyes wandering.

"He is in shock," said Piangthip Promphan, a child and adolescent psychiatrist of Samitivej Srinakarin Children's Hospital. "This is a common reaction after a tragic incident. Many survivors go through this feeling of numbness and disbelief."

Other reactions include aggression, tremendous fear and sadness, she added.

"We're observing them [children] closely and hope that all trauma symptoms will diminish and disappear after a month or at most six months after this tragedy," she said.

If this does not happen, the child psychiatrist said, affected children could develop bouts of flashbacks, nightmares, sleepless nights or anxiety attack for months or years. In the worst case scenario, the calamity may change their entire personality.

Many children were involved in the tragedy on the day after Christmas. Some lost their parents, others were injured. The psychological effects on children concern psychiatrists, who have lent their professional support at the Thammasat University Rangsit Campus.

"It's important that we know and are able to locate signs of anxiety disorders brought on by this tragedy, so that we can help them in time," said Piangthip.

The first reaction of victims is shock, she said.

"Children may appear numb, confused, speechless, or impassive. They may not mention the incident at all, act as if it had never happened. Or some may avoid associating with images or sounds related to the tragedy.

"This emotional detachment [for an extended time] after a trauma is not a healthy response at all," said Piangthip.

It is the mental defence mechanism that detaches or numbs individuals from feeling great pain, she explained.

In psychiatric theory, this repressed pain can put such individuals at greater risk for developing Post-Traumatic Stress Disorder later _ a matter of weeks, months or even years. The Web site of the National Association of School Psychologists in America suggests that children process their emotions and reactions to a trauma within 24 hours to 36 hours; more than this risks PTSD.

PTSD is considered an anxiety disorder. It can cause flashbacks, nightmares or frightening thoughts related to the tragedy.

"Children may become easily startled and agitated with the environment. They may startle when there is a strong wind. Or they cannot watch the images of the waves or the sea," said Piangthip, suggesting possible disorders after the southern tragedy. "Those things trigger bad and painful memories of loss. These children will be highly sensitive"

For children who show such distressing signs, the psychiatrist suggested they be removed from events or objects that remind them of the trauma. Adults should be sensitive when they mention the tsunami, even events related to it.

News broadcasts on television or radio should be monitored, perhaps switched off entirely at any onset of this anxiety disorder. No media interviews should be allowed at least until youngsters start to recover from the pain, and become calm.

Uncurbed trauma stimuli, the child psychiatrist worried, could hamper recovery from the anxiety disorder, and cause problems ranging from restless sleep and easily being startled to loss of interest in things once enjoyed, aggressive or violent behaviour, feelings of guilt, difficulty in concentrating and constant worry, especially about death.

Adults can detect signs of anxiety disorders from their children's physical problems. Headaches, stomach aches, immune system problems, dizziness, chest pain or discomfort in other parts of the body are warning signals.

PTSD does not naturally follow trauma, though. Most people will experience some of the symptoms of PTSD in the days and weeks following the trauma, but they will gradually decrease and eventually disappear within one to six months. If they persist longer, the child psychiatrist warned, it could be a signal of a serious emotional problem called chronic PTSD, and this requires professional help.

"These chronic anxiety symptoms can affect children's personality greatly. They might become a different person than they were before the tragic incident. They will become highly sensitive to the changing environment, fearful, easily startled, aggressive, depressed, or detached _ for example."

Some children who witnessed their parents being swept away may carry a sense of guilt that they could not hold on to their parents or they were part of their death.

"This will be a major complex that can affect them to adulthood. They may need therapists' assistance to clear this mental complex."

The psychiatrist said anxiety disorder or personality change may be caused by changes in the levels of body chemicals and hormones, affected by the sudden shock of the wave surge.

"It's like when you are in great panic or fear, the adrenaline rush can get some people to do what no one can expect from them, like carrying a fridge out of a burning house.

"This [disaster] can affect the body's chemicals in some way, too" she said.

People who have unbalanced body chemical problems will need proper medication to bring back the equilibrium, and may also need cognitive-behavioural therapy or play therapy, the child psychiatrist said.

Therefore, early detection, proper medical intervention and mental health treatment will help secure fast recovery of disaster victims from the traumatic stress anxiety. Other factors include the affected person's age and life background.

"Parents and guardians will have to pay extra attention to these affected children. Observe them closely, listen to them and lend emotional support," Piangthip suggested.

At present a number of children somehow isolated from their family are under the care of nurses and volunteers at hospitals or at Thammasat University. Piangthip is concerned that the confusing climate in the shelter and the fact that children are moved from hand to hand will have a psychological effect.

"Young children who are transferred from one caregiver to another can become confused and lost. If this continues for long, they may develop long-term mistrust of strangers," she said. "Young children need to build a mutual bond with someone, like the one they have with their parents. In case their parents are no longer alive, I think we need to establish an one-on-one relationship similar to parental care for these children so that they would not feel so stressful and insecure," she suggested.

For young children, reassurance is essential, she added. Very young children need a lot of cuddling as well as verbal support. And to rebuild the sense of security among pre-teen children, adults need to reassure them of their welfare, like where they are going to stay, who they are going to be with and what they will have to eat.

Apart from directly affected children, the psychiatrist stressed her concern over children in general, who these days may be riveted to the TV with their parents, watching the updated news on the southern rescue efforts. Such sad news and pictures of the disaster can affect their emotions and outlook in life too, said Piangthip.

"Even for us adults, we become stressed, sad and depressed when we watch and listen to the news. It's unnecessary to have children watch too much of this kind of news. They should do some other things or watch other programmes too," she said.

Adults may have to closely supervise or monitor children who might already be highly sensitive or easily anxious. "With those gruesome pictures on television, they may become even more anxious about things."

Parents also can take this opportunity to teach children about natural disasters, the truth of life, and life skills.

"We can teach our children that this is really a rare natural disaster, and discuss with them how it happened and what we should do in order to save our lives if such a thing happens again, or in other disastrous situations," Piangthip said.



- Observe children closely. Listen to what they say, including what they do not say. This can provide hints of what they are feeling.

- Young children deserve as much one-on-one care as soon as possible, to reestablish their sense of comfort and security from their parents.

- For older children and teenagers, their reaction to disaster often depends on the reaction of adults around them. So adults should be calm, warm and dependable so that the young people feel safe and assured. Adults who cry or become grief-stricken could exacerbate a child's emotional state.

- If youngsters want to talk about their experiences and feelings _ listen to them. The sooner they can do this after a traumatic event, the better.

- If children ask about the incident or their relatives, answer their questions honestly but without dwelling on frightening details.

- You can discuss actual events in this rare natural disaster with children, so they understand the big picture. But wait until children become more calm and emotionally stable before an extended discussion.

SOURCE: http://www.bangkokpost.com/en/Outlook/01Jan2005_out01.php

Chris Schuepp
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